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FACECNV&VII
PAROTIDGLAND
JacekBaj,MD,PhDDepartmentofHumanAnatomy
THESCALPThescalpiscomposedoffivelayers:SkinConnecAveAssueAponeurosisLooseconnecAveAssuePericranium
THEFACE
THESCALPThescalpiscomposedoffivelayers:SKIN:thin,exceptintheoccipitalregion,containingmanysweatandsebaceousglandsandhairfollicles.CONNECTIVETISSUE:richlyvascularizedsubcutaneouslayerthatiswellsuppliedwithcutaneousnerves.APONEUROSIS(epicranialaponeurosis):thebroad,strong,tendinoussheetthatcoversthecalvariaandservesastheaJachmentformuscleLOOSEAREOLARTISSUE:asponge-likelayerincludingpotenAalspacesthatmaydistendwithfluidasaresultofinjuryorinfecAon.PERICRANIUM:adenselayerofconnecAveAssuethatformstheexternalperiosteumoftheneurocranium
THEFACE
THEMUSCLESOFFACEANDSCALP• InnervatedbythefacialnerveCNVII,whichemergesfromthe
stylomastoidforamen• DerivaAvesofthe2ndpharyngealarch• Insertintotheskintoprovidemovement• Mostmusclesoffacialexpressionarelocalizedaroundthefacial
orifices• Thereisnodeepfasciaalongtheface
FacialnerveCNVIIsupplies
themusclesoffacialexpressionCNVII
THEMUSCLESOFFACEANDSCALP MUSCLESOFSCALP,FOREHEAD,ANDEYEBROWS
OCCIPITOFRONTALIS• Frontalbelly• Occipitalbelly
ORIGIN• Skinofeyebrows• Lateralpartofsuperior
nuchallineofoccipitalboneandmastoidprocessoftemporalbone
INSERTION• IntogaleaaponeuroAca• IntogaleaaponeuroAca
INNERVATIONFacialnerve[CNVII]
• Frontalbellymovesscalpforwardandraisestheeyebrows
• OccipitalbellymovesgaleaaponeuroAcabackward
THEMUSCLESOFFACEANDSCALP MUSCLESOFMOUTH,LIPS,ANDCHEEKS
THEORBICULARISORIS• controllingentryandexitthroughtheoralfissure• consistsoftwoparts
INNERVATION:FacialnerveCNVII
THEMUSCLESOFFACEANDSCALP MUSCLESOFMOUTH,LIPS,ANDCHEEKS
THEBUCCINATOR• aJacheslaterallytothealveolarprocessesofthe
maxillaeandmandible,oppositethemolarteeth,andtothepterygomandibularraphe,
• inserAon-angleofmouth(modiolus);orbicularisoris
INNERVATION:FacialnerveCNVII
THEBUCCINATORTheparoAdductpiercesthebuccinator.
THEBUCCINATOR• TheparoPdductpiercesthebuccinator.• InnervaAon– CNVII• Passingdeeptothemandible• Occupiesadeeper,moremediallyplacedplanethantheother
facialmuscles• Ismorecloselyrelatedtothebuccalmucosathantotheskinofthe
face
THEMUSCLESOFFACEANDSCALP MUSCLESOFMOUTH,LIPS,ANDCHEEKS
THEPTERYGOMANDIBULARRAPHEThepterygomandibularraphe,tendinousthickeningofthebuccopharyngealfasciaseparaAngandgivingorigintothesuperiorpharyngealconstrictorposteriorly.Itisconnectedwith:• buccinators• middlepharyngealconstrictor• pterygoidproccess• pterygoidhamulus
THEMUSCLESOFFACEANDSCALP MUSCLESOFMOUTH,LIPS,ANDCHEEKS
THEPLATYSMAORIGIN:SubcutaneousAssueofinfraclavicularandsupraclavicularregionsINSERTION:Baseofmandible;skinofcheekandlowerlip;angleofmouth(modiolus);orbicularisoris
INNERVATION:FacialnerveCNVII
THEPLATYSMACutaneousmuscleoccupyinganextensiveareaoftheneck.Itextendsfromthelowerpartofthefacetotheupperthorax
THEMUSCLESOFFACEANDSCALP MUSCLESOFMOUTH,LIPS,ANDCHEEKS
• Depressorangulioris• Depressorlabiiinferioris• Mentalis• Risorius• ZygomaAcusmajor• ZygomaAcusminor• Levatorlabiisuperioris• Levatorlabiisuperiorisalaequenasi • Levatorangulioris
INNERVATION:FacialnerveCNVII
THEMUSCLESOFFACEANDSCALP MUSCLESOFORBITALOPENING
• ORBICULARISOCULI• Palpebralpart• Orbitalpart
• CORRUGATORSUPERCILII
INNERVATION:FacialnerveCNVII
isdeeptotheeyebrowsandtheorbicularisoculimuscleandisacAvewhenfrowning.
THEMUSCLESOFFACEANDSCALP MUSCLESOFTHENOSE
• NASALIS• PROCERUS• DEPRESSORSEPTINASI
INNERVATION:FacialnerveCNVII
THENERVESOFFACEANDSCALP
• AllmotornervesarefromthefacialnerveCNVIIandsupplythemusclesoffacialexpression
• Sensorynervesofthefacearederivedmainlyfromthe3divisionsofthetrigeminalnerveCNV(V1,V2,V3)
• Somesensorybranchesarefromthecervicalplexus
Themusclesofthefacialexpression–thefacialnerveCNVIIThesensoryinnervaAon–cutaneousinnervaAonofthefaceisbybranchesofthetrigeminalnerve[CNV]
• ThefacialnerveCNVIIsuppliesthemusclesoffacialexpression• Sensorynervesofthefacearederivedmainlyfromthe3
divisionsofthetrigeminalnerveCNV(V1,V2,V3)• MusclesofmasPcaPonareinnervatedbyCNV3(mandibular
nerve,branchofthetrigemnalnerve)
THENERVESOFFACEANDSCALP Themusclesofthefacialexpression–thefacialnerveCNVII
Thefacialnerve(CNVII)exitsbetweentheponsandoliveandhastwodivisions:themotorrootandtheintermediatenerve,passeswiththevesAbulocochlearnerveintothepetroustemporalbone.
ThefacialnerveCNVIItraverses:• theposteriorcranialfossa• internalacousAcmeatus• facialcanal• stylomastoidforamenofthetemporalbone• andparoAdgland
Thelargermotorroot(facialnerveproper)innervatesthemusclesoffacialexpression.Thesmallerintermediatenervecarriestaste,parasympatheAc,andsomaAcsensoryfibers.
THENERVESOFFACEANDSCALP
Themusclesofthefacialexpression–thefacialnerveCNVII
Thefacialnerve[CNVII]exitstheposteriorcranialfossathroughtheinternalacousAcmeatus.
Itpassesthroughthetemporalbone,alongthemedialwallofthetympaniccavity,givingoffseveralbranches,andemergesfromthebaseoftheskullthroughthestylomastoidforamen,locatedbetweenthemastoidandthestyloidprocesses.
Thelargermotorroot(facialnerveproper)innervatesthemusclesoffacialexpression.Thesmallerintermediatenervecarriestaste,parasympatheAc,andsomaAcsensoryfibers.
THENERVESOFFACEANDSCALP
Themusclesofthefacialexpression–thefacialnerveCNVII
Sensory:specialsensory(taste)andsomaAc(general)sensory.Motor:somaAc(branchial)motorandvisceral(parasympatheAc)motor.ItalsocarriespropriocepAvefibersfromthemusclesitinnervates.Nuclei:Themotornucleusofthefacialnerveisabranchiomotornucleusintheventrolateralpartofthepons.Thecellbodiesoftheprimarysensoryneuronsareinthegeniculateganglion.
THEFACIALNERVE
THENERVESOFFACEANDSCALP
Themusclesofthefacialexpression–thefacialnerveCNVII
THEBRANCHESWhiletraversingthetemporalbonewithinthefacialcanal,CNVIIgivesrisetothe:• Greaterpetrosalnerve:emergingfromtheanteriorwallofthepetrouspartof
thetemporalbone.ItincorporatesparasympatheAcandsensoryfibers,andpenetratesthecoveringplateoftheforamenlacerumlateraltotheinternalcaroAdarterywhereitisjoinedbythedeeppetrosalnerve.
• Nervetothestapedius:slenderbranchsupplyingthestapediusmuscle.
• Chordatympaninerve:nervebundlewithparasympatheAcfibersforthesubmandibularglandandsensoryfibersfromthetastebudsoccupyingtheanterior2/3ofthetongue.
THEFACIALNERVE
THENERVESOFFACEANDSCALP
Themusclesofthefacialexpression–thefacialnerveCNVII
THEBRANCHESCNVIIemergesfromthecraniumviathestylomastoidforamen:• atthispointitgivesofftheposteriorauricularbranch-thisbranchpasses
upward,behindtheear,tosupplytheoccipitalbellyoftheoccipitofrontalismuscleofthescalpandtheposteriorauricularmuscleoftheear
• themainstemofthefacialnervethengivesoffanotherbranch,whichinnervatestheposteriorbellyofthedigastricmuscleandthestylohyoidmuscle
• atthispoint,thefacialnerveentersthedeepsurfaceoftheparoPdgland;• onceintheparoAdgland,themainstemofthefacialnerveusuallydivides
intoupper(temporofacial)andlower(cervicofacial)branches• theymaybranchfurtherortakepartinananastomoAcnetworkandform
theparoPdplexus,whichgivesrisetothefiveterminalmotorbranches:temporal,zygomaPc,buccal,marginalmandibular,andcervical
THEFACIALNERVE
THENERVESOFFACEANDSCALP
Themusclesofthefacialexpression–thefacialnerveCNVII
TemporalbranchesexitfromthesuperiorborderoftheparoAdglandtosupplymusclesintheareaofthetemple,forehead,andsupra-orbitalarea.ZygomaPcbranchesemergefromtheanterosuperiorborderoftheparoAdglandtosupplymusclesintheinfra-orbitalarea,thelateralnasalarea,andtheupperlip.BuccalbranchesemergefromtheanteriorborderoftheparoAdglandtosupplymusclesinthecheek,theupperlip,andthecornerofthemouth.MarginalmandibularbranchesemergefromtheanteroinferiorborderoftheparoAdglandtosupplymusclesofthelowerlipandchin.CervicalbranchesemergefromtheinferiorborderoftheparoAdglandtosupplytheplatysma.
THEFACIALNERVE
THENERVESOFFACEANDSCALP
Themusclesofthefacialexpression–thefacialnerveCNVII
SOMATIC(BRANCHIAL)MOTORThefacialnervesuppliesmainlythemusclesoffacialexpressionandauricularmuscles.Italsosuppliestheposteriorbelliesofthedigastric,stylohyoid,andstapediusmuscles.VISCERAL(PARASYMPATHETIC)MOTORCNVIIprovidespresynapAcparasympatheAcfibersto:• thepterygopalaPneganglionviathegreaterpetrosalnerveforinnervaAon
ofthelacrimalglands,andto• thesubmandibularganglionchordatympaniforinnervaAonofthesublingual
andsubmandibularsalivaryglands.SOMATIC(GENERAL)SENSORYSomefibersfromthegeniculateganglionsupplyasmallareaoftheskinoftheconchaoftheauricle,closetoexternalacousAcmeatus.SPECIALSENSORY(TASTE)FiberscarriedbythechordatympanijointhelingualnervetoconveytastesensaAonfromtheanteriortwothirdsofthetongueandsogpalate.
THEFACIALNERVE
THENERVESOFFACEANDSCALP
Thetrigeminalnerve[CNV]innervatesfacialstructuresderivedfromthefirstarch.Thefacialnerve[CNVII]innervatesfacialstructuresderivedfromthesecondarch.
Duringdevelopmentacranialnervebecomesassociatedwitheachofthepharyngealarches.
THENERVESOFFACEANDSCALP
ThetrigeminalnerveCNV
FUNCTIONS:SomaAc(general)sensoryandsomaAc(branchial)motortoderivaAvesofthe1stpharyngealarch.NUCLEI:Thereare4trigeminalnuclei–onemotor(motornucleusoftrigeminalnerve)andthreesensory(mesencephalic,principalsensoryandspinalnucleioftrigeminalnerve).
Thetrigeminalnerveexitslaterallyfromtheponswithtwogroupsoffibers(largeposteriorsensoryandsmallanteriormotorrootsoftrigeminalnerve),suppliesthemasAcaAonmusclesandprovidessensoryinnervaAontotheface.
ThetrigeminalnerveCNVistheprincipalsomaAc(general)sensorynerveforthehead(face,teeth,mouth,nasalcavity,andduramaterofthecranialcavity).
Thesensoryrootleadstothetrigeminalganglion.Themotorrootrunsparalleltothesensoryroot,thenbypassestheganglionandbecomespartofthemandibularnerve(CNV3)
THENERVESOFFACEANDSCALP
ThetrigeminalnerveCNV
TRIGEMINAL(SEMILUNAR,GASSERIAN)GANGLIONSemilunarganglionthatisequivalenttoaspinalganglion.ItislocatedinanoutpockeAngofthesubarachnoidspace(cavumtrigeminale)abovetheforamenlacerumatthemedial,anteriorborderofthepetrouspartofthetemporalbone.
TheophtalmicV1andmaxillaryV2divisionsarewhollySENSORY.ThemandibularV3divisionislargelysensory,butalsoreceivesthemotorfibresthatsupplythemusclesofmasPcaPon.
Thetrigeminalnerveisdividedasfollows:• ophthalmicV1division:exitstheskullviathesuperiororbitalfissure• maxillaryV2division:exitstheskullviatheforamenrotundum• mandibularV3division:exitstheskullviatheforamenovale
THENERVESOFFACEANDSCALP
ThetrigeminalnerveCNV
ThebranchesoftheophthalmicnerveV1thatinnervatethefaceinclude:• thesupra-orbitalandsupratrochlearnerves(fromfrontalnerve),whichleave
theorbitsuperiorlyandinnervatetheuppereyelid,forehead,andscalp;
• theinfratrochlearnerve,whichexitstheorbitinthemedialangletoinnervatethemedialhalfoftheuppereyelid,theskinintheareaofthemedialangle,andthesideofthenose;
• thelacrimalnerve,whichexitstheorbitinthelateralangletoinnervatethelateralhalfoftheuppereyelidandtheskinintheareaofthelateralangle;and
• theexternalnasalnerve,whichsuppliestheanteriorpartofthenose.
THENERVESOFFACEANDSCALP
ThetrigeminalnerveCNV
Thetrigeminalnerveisdividedasfollows:• maxillaryV2division:exitstheskullviatheforamenrotundumItpassesthroughtheforamenrotundumtothepterygopalaAnefossaandsubsequentlythroughtheinferiororbitalfissureintotheorbit.
Thetrigeminalnerveisdividedasfollows:• maxillaryV2division:exitstheskullviatheforamenrotundumItssomaAc(general)sensoryfibersaregenerallydistributedtoskinandmucousmembranesassociatedwiththeupperjaw.
THENERVESOFFACEANDSCALP
ThetrigeminalnerveCNV
ThebranchesoftheMAXILLARYNERVEV2thatinnervatethefaceinclude:• asmallzygomaPcotemporalbranch,whichexitsthezygomaAcboneand
suppliesasmallareaoftheanteriortempleabovethezygomaAcarch;
• asmallzygomaPcofacialbranch,whichexitsthezygomaAcboneandsuppliesasmallareaofskinoverthezygomaAcbone;and
• thelargeinfra-orbitalnerve,whichexitsthemaxillathroughtheinfra-orbitalforamenandimmediatelydividesintomulAplebranchestosupplythelowereyelid,cheek,sideofthenose,andupperlip
THENERVESOFFACEANDSCALP
ThetrigeminalnerveCNV
THEPTERYGOPALATINE(PARASYMPATHETIC)GANGLIONisassociatedwiththisdivisionofCNV,involvedininnervaAngthelacrimalglandandglandsofthenoseandpalate.
OPHTHALMICNERVE(CNV1)-SENSORYONLYMAXILLARYNERVE(CNV2)-SENSORYONLYMANDIBULARNERVE(CNV3)-SENSORYANDMOTOR
THENERVESOFFACEANDSCALP
ThetrigeminalnerveCNV
THESOMATIC(BRANCHIOMOTOR)BRANCHESOFTHETRIGEMINALNERVETHEMANDIBULARNERVEV3ONLY(!):• masseter• temporalis• medialandlateralpterygoids• mylohyoid• anteriorbellyofdigastric• tensortympani
THENERVESOFFACEANDSCALP
BuccalbranchesemergefromtheanteriorborderoftheparoAdglandtosupplymusclesinthecheek,theupperlip,andthecornerofthemouth.
THEFACIALNERVE
ThebranchesofthemandibularnerveV3innervaAngthefaceinclude:• thebuccalnerve,whichisonthe
surfaceofthebuccinatormusclesupplyingthecheek;
THEMANDIBULARNERVEVS.
BRANCHES NERVE
THENERVESOFFACEANDSCALP
ThetrigeminalnerveCNV
ThebranchesofthemandibularnerveV3innervaAngthefaceinclude:• theauriculotemporalnerve,whichentersthefacejustposteriortothe
temporomandibularjoint,passesthroughtheparoAdgland,andascendsjustanteriortotheeartosupplytheexternalacousAcmeatus,thesurfaceofthetympanicmembrane(eardrum),andalargeareaofthetemple;
• thebuccalnerve,whichisonthesurfaceofthebuccinatormusclesupplyingthecheek;and
• thementalnerve,whichexitsthemandiblethroughthementalforamenandimmediatelydividesintomulAplebranchestosupplytheskinandmucousmembraneofthelowerlipandskinofthechin.
THENERVESOFFACEANDSCALP ThetrigeminalnerveCNV
OPHTHALMICNERVE(CNV1)-SENSORYONLYMAXILLARYNERVE(CNV2)-SENSORYONLYMANDIBULARNERVE(CNV3)-SENSORYANDMOTOR
THENERVESOFFACEANDSCALP
ThetrigeminalnerveCNV
THESOMATIC(BRANCHIOMOTOR)BRANCHESOFTHETRIGEMINALNERVETHEMANDIBULARNERVEV3ONLY(!):• masseter• temporalis• medialandlateralpterygoids• mylohyoid• anteriorbellyofdigastric• tensortympani
THETRIGEMINALNERVECNVissensoryto:• theduraoftheanteriorandmiddlecranialfossae• skinoftheface• teeth• gingiva• mucousmembraneofthenasalcavity• paranasalsinuses• andmouth
THENERVESOFFACEANDSCALP
ThetrigeminalnerveCNV
TwoparasympatheAcganglia,theoPcandsubmandibular,areassociatedwiththemandibulardivisionV3;bothareconcernedwiththeinnervaAonofsalivaryglands.
THENERVESOFFACEANDSCALP
Thespinalcutaneousnerves
Posteriortotheear,thescalpreceivescutaneousinnervaAonfromthespinalcutaneousnervesthatoriginateintheneck(C2,C3):• greateroccipitalnerve(C2)• lesseroccipitalnerve(C2,C3)• thirdoccipitalnerve(C3)
THEVASCULATUREOFFACIALANDSCALP
THESUPERFICIALARTERIESOFFACE
THESUPERFICIALARTERIESOFFACEANDSCALP:• Facial• Inferiorlabial• Superiorlabial• Lateralnasal• Angular• Occipital• Posteriorauricular• Superficialtemporal• Transversefacial• Mental• Supra-orbital• Supratrochlear
MostsuperficialarteriesofthefacearebranchesorderivaAvesofbranchesoftheexternalcaroAd
artery
THEVASCULATUREOFFACIALANDSCALP
THESUPERFICIALARTERIESOFFACE
THEFACIALARTERYThirdanteriorbranchofexternalcaroAdartery.Itrunsbelowthestylohyoidmuscle,firstupward,thenlateral,andcrossesthemandibleattheanteriormarginofthemasseter.
THEFACIALARTERYcrossesthemandibleattheanteriormarginofthemasseter.
THEFACIALARTERYThefacialarterycrossesthemandible,buccinator,andmaxillaasitcoursesoverthefacetothemedialangle(canthus)oftheeye,wherethesuperiorandinferioreyelidsmeet.
THEFACIALARTERYThefacialarteryprovidesthemajorarterialsupplytotheface.
THEVASCULATUREOFFACIALANDSCALP
THESUPERFICIALARTERIESOFFACE
THEFACIALARTERYThefacialarterypassesapproximatelyafinger’sbreadthlateraltotheangleofthemouth
THEFACIALARTERYsendsbranchestotheupperandlowerlips(thesuperiorandinferiorlabialarteries),ascendsalongthesideofthenose.Theterminalpartofthefacialarteryiscalledtheangularartery,itanastomoseswiththeophthalmicartery.
THEVASCULATUREOFFACIALANDSCALP
THESUPERFICIALARTERIESOFFACE
THEOCCIPITALARTERYSeconddorsalbranchofexternalcaroAdartery.Itpassesmedialtothemastoidprocessattheocciputandanastomoseswiththesuperficialtemporal,vertebral,deepcervicalandposteriorauriculararteries.
THEPOSTERIORAURICULARARTERYThirddorsalbranchofexternalcaroAdartery.ItliesundertheparoAdglandonthestyloidprocessbetweenthemastoidprocessandtheear.
THESUPERFICIALTEMPORALARTERYOneoftwoterminalbranchesoftheexternalcaroAdartery.Itpassesupwardinfrontoftheauricle(pinna)accompaniedbytheauriculotemporalnerve.
THETRANSVERSEFACIALARTERYBranchofthesuperficialtemporalartery,thatiscoveredbytheparoAdglandandpassesbelowthezygomaAcarchtothecheek.Approximatelyafinger’sbreadthinferiortothezygomaAcarch.
THEVASCULATUREOFFACIALANDSCALP
THESUPERFICIALARTERIESOFFACE
THEMENTALARTERYTerminalbranchofinferioralveolarartery.Theonlysuperficialbranchderivedfromthemaxillaryartery,accompaniesthenerveofthesamenameinthechin.
*
THESUPRAORBITALandSUPRATROCHLEARARTERIESThebranchesoftheophthalmicartery,accompanynervesofthesamenameacrosstheeyebrowsandforehead.
THEVASCULATUREOFFACIALANDSCALP
THEARTERIESOFSCALP
THEARTERIESOFSCALPThearterialsupplyisfromtheexternalcaroAdarteriesthrough:• theoccipital• posteriorauricular• andsuperficialtemporalarteriesAndfromtheinternalcaroAdarteriesthrough:• thesupratrochlear• andsupra-orbitalarteries
THEEXTERNALVEINSOFFACE• Supratrochlear• Supra-orbital• Angular• Facial• Deepfacial• Superficialtemporal• Retromandibular
THEVASCULATUREOFFACIALANDSCALP
THEFACIALVEINSThefacialveins,coursingwithorparalleltothefacialarteries,arevalvelessveinsthatprovidetheprimarysuperficialdrainageoftheface.Itcoursesfromthemedialangleoftheeye,behindthefacialartery.Thefacialveindrainsdirectlyorindirectlyintotheinternaljugularvein.
THEEXTERNALVEINSOFFACEOFSCALP
THEFACIALVEINSAtthemedialangleoftheeye,thefacialveincommunicateswiththesuperiorophthalmicvein,whichdrainsintothecavernoussinus.
THEANGULARVEINFormedbytheunionofthesupratrochlearandsupraorbitalveins;itbecomesconAnuouswiththefacialveinatthemedialangleoftheeyeandanastomoseswiththeophthalmicvein.
THEVASCULATUREOFFACIALANDSCALP
THEDEEEPFACIALVEINArisesfromthepterygoidplexus(drainsthepterygoidvenousplexusoftheinfratemporalfossa)andpassesanteriorlyonthemaxilla.
THEEXTERNALVEINSOFFACEOFSCALP
THERETROMANDIBULARVEINItdrainsintothefacialveinagerreceivingtheconfluenceofmanybranchesinfrontoftheear.TheretromandibularveindividesintoananteriorbranchthatuniteswiththefacialveinandaposteriorbranchthatjoinstheposteriorauricularveininferiortotheparoAdglandtoformtheexternaljugularvein.Thisveinpassesinferiorlyandsuperficiallyinthenecktoemptyintothesubclavianvein.
THEVASCULATUREOFFACIALANDSCALP
THEVEINSOFSCALP
THEVEINSOFSCALPThesupra-orbitalandsupratrochlearveinsuniteatthemedialcanthusoftheeyetoformthefacialvein.Thesuperficialtemporalveinjoinsthemaxillaryveintocreatetheretromandibularveinjustposteriortotheneckofthemandible.Theposteriorauricularveinoriginatesbehindtheearandchannelsvenousbloodfromtheposteriorofthescalptowardtheexternaljugularvein.
THEVASCULATUREOFFACIALANDSCALP THEVEINSOFSCALP
THEVEINSOFFACIALANDSCALPSomesmallveinsalsocommunicatewiththecavernoussinuswithintheskull.ThisconnecAonoffacialvenousdrainagewithintracranialvenousdrainageaccountsforthespreadofsomeinfecPonsfromthefacetothebrain.
ThethrombophlebiPsofthecavernoussinusmaybecausedbyaninflammaAonlimitedtothe:• medialangleoftheeye• upperlip
THEVASCULATUREOFFACIALANDSCALP THECAVERNOUS SINUS
Cranial nerves: oculomotor CN III, trochlear IV and abducent VI and the ophthalmic V1 and maxillary V2 divisions of CN V, as well as the internal carotid artery and its periarterial plexus of postganglionic sympathetic fibers traverse the CAVERNOUS SINUS.
AllofthesecranialnervescourseinthelateralwallofthesinusexceptforabducentCNVI,whichcoursesthroughthemiddleofthesinus.Asaresult,CNVIistypicallyaffectedfirstinacavernoussinusthrombosisorbyananeurysmoftheinternalcaroAdartery,withtheothernervesbeingaffectedlater.
THEVASCULATUREOFFACIALANDSCALP
THELYMPHATICDRAINAGEOFFACEANDSCALP
LYMPHATICDRAINAGEOFFACEANDSCALP• Lymphfromthelateralpartofthefaceandscalp,includingtheeyelids,drainsto
thesuperficialparoAdlymphnodes.
• LymphfromthedeepparoAdnodesdrainstothedeepcervicallymphnodes.
• Lymphfromtheupperlipandlateralpartsofthelowerlipdrainstothesubmandibularlymphnodes.
• Lymphfromthechinandcentralpartofthelowerlipdrainstothesubmentallymphnodes.
LYMPHATICDRAINAGEOFFACEANDSCALPTherearenolymphnodesinthescalp,andexceptfortheparoAd/buccalregion,therearenolymphnodesintheface.
THEVASCULATUREOFFACIALANDSCALP
THELYMPHATICDRAINAGEOFFACEANDSCALP
LYMPHATICDRAINAGEOFFACEANDSCALPThesuperficialring(pericervicalcollar)oflymphnodes:• submental• submandibular• paroAd• mastoid• andoccipitalLymphfromthescalp,face,andneckdrainsintothesuperficialringoflymphnodes
LYMPHATICDRAINAGEOFFACEANDSCALPAlllymphaAcvesselsfromtheheadandneckdraindirectlyorindirectlyintothedeepcervicallymphnodes
THEPAROTIDGLAND
THEPAROTIDREGION
THEPAROTIDREGIONTheparoAdregionistheposterolateralpartofthefacialregion,boundedbythe:• ZygomaAcarchsuperiorly• Externalearandanteriorborderofthesternocleidomastoidposteriorly• Ramusofthemandiblemedially• Anteriorborderofthemassetermuscleanteriorly• Angleandinferiorborderofthemandibleinferiorly
THEPAROTIDREGIONTheparoAdregionincludes:• theparoAdglandandduct• theparoAdplexusofthefacialnerve(CNVII)• theretromandibularvein• theexternalcaroAdartery• andthemassetermuscle
THEPAROTIDGLAND
THEPAROTIDGLANDTheparoAdglandisenclosedwithinatough,unyielding,theparoPdsheath(capsule)
THEPAROTIDGLANDTheapexoftheparoAdglandisposteriortotheangleofthemandible,anditsbaseisrelatedtothezygomaAcarch.
THEPAROTIDDUCTTheparoAdductpasseshorizontallyfromtheanterioredgeofthegland• theductturnsmedially• piercesthebuccinator• andenterstheoralcavitythroughasmallorificeoppositethe
2ndmaxillarymolartooth
THEPAROTIDGLAND
THEPAROTIDGLANDFromsuperficialtodeepthereare:• theparoAdplexusofthefacialnerve(CNVII)anditsbranches• theretromandibularvein• theexternalcaroAdartery
TheparoAdectomymaydamagethefacialnerveCNVII(theparoAdplexus)
THEPAROTIDGLANDOntheparoAdsheathandwithintheglandareparoAdlymphnodes.